Liu Shen-Ing, Lu Ru-Band, Lee Ming-Been
Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2008 Dec;107(12):921-31. doi: 10.1016/S0929-6646(09)60015-2.
BACKGROUND/PURPOSE: Depression is a major health concern, often treated by non-psychiatrists. This study assessed self-reported knowledge, attitudes and treatment practices of non-psychiatric physicians in the recognition and management of depression.
Survey questionnaires were given to non-psychiatric physicians who attended a depression training program. We asked physicians about their current clinical practice, knowledge, confidence, attitudes and perceived barriers to care regarding recognition and management of patients with depression.
Of 524 eligible non-psychiatric physicians, 375 (72%) completed surveys. The majority of physicians held a strong sense of responsibility for managing depression, although they provided treatment to only a small proportion of depressed patients. Most of them were not confident treating depressed patients, and they reported that incomplete knowledge and training were major barriers that limited their involvement. The patient and organization barriers were not related to reported management, but the physician barriers (lack of skills and knowledge in managing depression) were related to reported rate of treatment. Age, prior depression training, and education were major contributing factors to domains of knowledge, attitude and behavior, in terms of the number of domains involved. Family physician orientation was associated with higher score on knowledge scale, but not with other variables of attitude and behavior.
Our study suggests that non-psychiatrists may also play a role in the care of depression, but identifying and managing depression can be a challenge to them. Attitudinal barriers, confidence, and knowledge of treatment may compromise the physicians ability to manage depression. Future interventions and educational efforts need to address each of these issues.
背景/目的：抑郁症是一个主要的健康问题，常由非精神科医生进行治疗。本研究评估了非精神科医生在抑郁症识别与管理方面自我报告的知识、态度及治疗实践情况。
向参加抑郁症培训项目的非精神科医生发放调查问卷。我们询问医生关于他们当前的临床实践、知识、信心、态度以及在抑郁症患者识别与管理方面所感知到的护理障碍。
在524名符合条件的非精神科医生中，375名（72%）完成了调查。大多数医生对管理抑郁症负有强烈的责任感，尽管他们仅为一小部分抑郁症患者提供治疗。他们中的大多数人对治疗抑郁症患者缺乏信心，并且报告称知识不完整和培训不足是限制他们参与的主要障碍。患者和组织方面的障碍与报告的管理情况无关，但医生方面的障碍（在管理抑郁症方面缺乏技能和知识）与报告的治疗率相关。就所涉及的领域数量而言，年龄、先前的抑郁症培训和教育是知识、态度和行为领域的主要影响因素。家庭医生导向与知识量表上的较高得分相关，但与态度和行为的其他变量无关。
我们的研究表明，非精神科医生在抑郁症护理中也可能发挥作用，但识别和管理抑郁症对他们来说可能是一项挑战。态度障碍、信心和治疗知识可能会损害医生管理抑郁症的能力。未来的干预措施和教育工作需要解决这些问题。
